One of the big debates that comes up over and over in sex education is the role and effectiveness of the strategy of harm reduction. And part of why it’s tricky is that a lot of people have so many judgments and opinions about sexual practices that it’s hard to have a reasonable discussion. When folks can’t separate their discomfort, triggers, and squicks from the discussion of sexual practices, things go nowhere fast. So I’d like to use an example from my life that illustrates the value of harm reduction.
First, a little background. I’m pre-diabetic. My body is somewhat resistant to insulin, so even when there’s fuel in my system, it doesn’t get transported into my cells as efficiently as it might. This makes it harder for my body to regulate my blood sugar. I’m at the high end of the “normal” range on my blood tests, which means that I can manage things with a careful diet and regular exercise. My goal is to avoid shifting into actual diabetes for as long as possible.
To make that happen, I’m super careful about what I eat. I don’t eat any sugar or corn syrup (which means almost no processed food of any kind), no wheat, potatoes, white rice, or other high glycemic index foods. I eat a careful balance of complex carbohydrates and protein at every meal and I eat several servings of fruit and vegetables almost every day. It’s not an easy thing to do and it requires bringing food with me wherever I go, planning my meals in advance, and always having a snack for those times when I need it. The payoff is that my mood is more even, my body feels better, and (hopefully) I’m delaying the slide into actual diabetes.
But the thing is- I’m surrounded by temptation. Everywhere I go, there’s candy, fast food, potato chips, and food options that are much easier and much less expensive. (Have you ever noticed that the food that’s cheap to produce in large quantities is exactly the stuff that’s bad for us?) It’s not easy to go to a birthday party and not be able to eat the cake. It’s not easy to say “no, thanks” every time someone offers me some potato chips. And it’s not easy to be consistent with myself.
One book I read on the topic suggested going on a small binge every so often. The reasoning is that it makes you feel so icky afterward that it reminds you to stick with the diet on a daily basis. The author suggested that an occasional and deliberate indulgence with subsequent hangover is less harmful than a daily, but smaller snack since the discomfort from the binge helps you keep yourself in line. I’ve found that to be a pretty good strategy.
What also helps is what my partner & I call “harm reduction cookies.” She likes to bake, but she’s also a nurse who has seen what diabetes can do and she doesn’t want that to happen to me. So she’s developed some recipes that are less harmful- they use sucanat instead of white sugar and spelt flour instead of wheat. There are other modifications, too, but I don’t know what they are since my role in the kitchen centers on cleaning things up and being the barback.
The great thing about this is that, although these cookies are still treats and I don’t get to pig out on them, they are less difficult for my body to manage and they cause less of a blood sugar response than thin mints or orange milanos (my former favorite cookies). And if I have one for dessert, the food already in my stomach further buffers the effect. So they’re harm reduction cookies because they minimize the impact on my system and they keep me from being tempted by the candy that’s so prominently displayed at the supermarket checkout stand. No, it’s not perfect but it’s unreasonable for me to expect myself to be perfect. In fact, the harder I aim for perfection, the more I feel tempted. If I give myself a little wiggle room, the net effect is a vast improvement.
Harm reduction was especially helpful when I was just starting to figure out how to change my food habits and practices. After all, I didn’t just wake up one day and have the system I have now. I started off by cutting some things out, but leaving myself that wiggle room. And at each step of the way, as my diet improved, my harm reduction shifted, too. Having a little flexibility was a much more effective way to make the gradual shifts that support long-term change. If someone had said to me at the beginning that I needed to do everything all at once, I would have felt overwhelmed and I simply couldn’t have done it. One step at a time got me where I needed to go.
This is exactly how harm reduction works, whether we’re talking about food, balancing your budget, sex, or drugs. It works because it helps people take the next step without forcing them to go any further than they can at that point in their lives. Some folks will be able to walk along that path further than others, but no matter how far each person goes, the overall effect is an improvement.
By removing sex or drugs from the equation, it’s easy to see how obvious harm reduction is. I’m willing to bet that most of you have done something along these lines at some point in your lives. But when we add sex or drugs into the mix, people often stop thinking clearly about it. I can only assume that our irrational phobias and internalized judgments about them are what get in the way. But that doesn’t change the fact that harm reduction works. It’s an incredibly powerful tool to have in our box.
When it’s done well, harm reduction isn’t the message “it’s ok to do this.” It’s the message that “this is less harmful than what you would have done.” It’s neither condoning nor condemning the person. It’s acknowledging that it’s hard to change habits and any movement towards the positive is a good thing. It isn’t a one-size-fits-all approach. It has to be tailored for each individual since we each have our own challenges and we’re constantly moving along the spectrum of harm-no harm. And it isn’t coddling people or making excuses for them. It’s challenging them to take the next step and when they do that, it’s asking them to take the one after that.
I’ve never understood why so many people attack harm reduction work. The research and lots of people’s personal experiences show that it’s effective. It does the job of helping people make different decisions. Granted, it’s not equal, in the sense that what one person does isn’t appropriate for someone else to do. But it’s fair because we’re each in a different place in our lives and some people need looser limits while other people need tighter ones. What’s unfair is expecting everyone to be able to comply with the same rules despite the vast diversity in our experiences. Think about it- is it fair to expect a couch potato to suddenly be a marathon runner? Of course not! They’d need to start off slowly and ramp up.
Harm reduction is a lot more work than laying down the law because it works best when there’s a real relationship between the person trying to make a change and the people supporting & challenging them. It’s more work because it requires a constant assessment of where things are today, in this moment, rather than following a script. It’s more work because if you want to use it to help others, you’d better model it or you lose credibility. You have to walk the walk or they won’t listen to you. And it’s more work because you need to constantly practice letting go of the judgments that hinder the process.
Ultimately, harm reduction is harder to do because it necessitates letting go of the belief that we can control other people. We have to give them the choices and support them as they struggle to make the best decisions they can, even when we disagree with them or when we want them to do something different. And maybe one reason that so many people deny its effectiveness is because they can’t let go of trying to control other people, so they can’t admit that harm reduction might work. It’s scary to acknowledge that someone else might decide to do something that puts them in harm’s way, especially if it’s someone we care about.
But in the end, a harm reduction model helps them learn the skills they need to keep themselves safe(r). And that is a much better way to help someone grow and stand on their own two feet.